PCN (Percutaneous Nephrostomy) Surgery

PCN (percutaneous nephrostomy)

Percutaneous nephrostomy is a method by which radiological guidance ensures percutaneous access to the kidney. The access is also maintained through the use of a catheter.

Indications

Percutaneous nephrostomy is usually used for ineffective or complicated retrograde strategies. Includes clinical conditions:

• Obstruction of the urinary tract.
• Diversion of the urine (e.g. ureteric lesion as well as leakage of urine).
• Percutaneous procedures access (e.g. stone treatment; ureteric antegrade stenting).
• Checking for diagnosis (e.g. pyelography antegrade, an examination of Whitaker).

Contrasting of the Comprehensive contraindications

• None normally

Relative contraindications

• Diathesis with incorrect bleeding (abnormal indices of coagulation)
• Patient uncooperative
• Extreme respiratory problems
• Severe hyperkalemia and/or metabolic acidosis has not been corrected
• Urgenthemodialysis may correct metabolic disorder prior to the insertionof nephrostomy.

Procedure of PCN

Assessment of pre-procedure

• To confirm the procedure indication and evaluate renal anatomy, review all the images available and identify safe access pathways to the kidney
• To determine the possibility of hemorrhage, review the overall blood count and coagulation profile
• Get informed procedural consent
• Get good access to IV peripheral
• If required, administration of IV broad-spectrum antibiotics 1-4 hours before the procedure; sometimes even, parenteral antibiotics in septic patients.

Placement

Depending on the clinical circumstances and patient comfort, the procedure is performed in a prone, inclined, or lateral position. During the procedure, it is recommended that a properly trained specialist monitor vital signs. Clean skin with antiseptic solution and drape to keep the procedure sterile.

Equipments

• Guidelines for ultrasound or fluoroscopy
• 7-9 French mist dilators
• 1 or 2 percent lidocaine local anesthesia
• water-soluble contrast media
• A micropuncture set with a needle of 21 or 22 gages would serve as an option
• The stiff guidewire of 0.035 “(Micropuncture set also has a 0.018 guidewire)
• 8 French pigtail drain

Medications

• prophylactic antibiotics, chosen patients the usage of antibiotics is usually 3rd generation of cephalosporin, not normal.
• Fentany l, not used routinely but can assist with collaborations with patients selected (e.g. meperidine).
• Sedation-a short-acting benzodiazepine in selected patients may be used.

Technique

There are two common methods.

The selection of the technology depends on the operator and the patient. A two or three-part punching point needle, and a micropuncture set are used in one method.

The calyx is penetrated with an 18 inch, two-part needle under ultrasound direction by way of the aseptic procedure and subsequent penetration of local anesthesia agents. Urine drains freely from the needle in the event of a renal tract obstruction. To validate the right needle location with fluoroscopy, a limited volume of water-soluble contrast content may be inserted. The needle is replaced by a guidewire 0.035 and an 8 French pigtail drain is typically placed over the guidewire within the renal pelvic pelvis.

A catheter 6F or 12F on a case-by-case basis can be used. For microbiological studies, a urine sample can be sent to the lab. The catheter remains free to drain.